Barry Blackwell’s reply to Donald F. Klein’s comment

Don Klein’s rapid and kind response to my essay is doubly welcome. It makes excellent points and reinforces the unique value of INHN in creating a forum for easy dialog on important matters.

First and foremost, it is important to acknowledge that my essay was a synopsis based on secondary sources, albeit seven well referenced and reviewed books from diverse points of view. While it was impossible to fact check such a massive database, it can fairly be considered a reasonably valid representation of opinions from a spectrum of viewpoints.

These tend to support my personal perception that the problem we face is not solely the responsibility of the pharmaceutical industry but is part of a broader malaise in which the public and our profession are complicit. In America, we have medicalized the management of ill health and adopted a chemophilic response to it that minimizes the value of healthy lifestyles as well as psychological and social avenues of intervention.

In some ways, this can be attributed to the unfulfilled hopes of the psychopharmacology revolution generated in the mid-20th century. Some of our contemporary concerns are reflected in David Healey’s essay, The Shipwreck of the singular, (INHN.org Controversies: 1.28.2016) to which several INHN members responded but still await replies. My personal views on the part played by the medical profession are expressed there (INHN.org Controversies: 4.21. 2016) and my thoughts on the etiology and management of anxiety disorders in an earlier essay, The Anxiety Enigma (INHN.org 10.30.2014).

To be more specific the problem is not intrinsic to the DSM system itself but to the way in which it is used by the profession and manipulated by industry so that nothing but an Axis 1 diagnosis will suffice to support insurance and advertising claims.

Three days before my essay was posted on INHN, the New York Times (8.28.2016) published a review of another (eighth) book on our topic by their investigative reporter, Alan Schwartz, titled “ADHD Nation”. The reviewer, Steve Silberman, notes that the author does not deny the validity of the DSM diagnosis but explores the manner in which it has been willfully manipulated and its scope expanded by, “an unholy alliance between drug makers, academic psychiatrists, policy makers and celebrity shills.” This has created “an ADHD industrial complex, insidiously selling the disorder rather than the drugs in the guise of promoting ADHD awareness.” Silberman goes on to note this has created, “a self-affirming circle of science, one that has quashed all dissent.” The bulk of the evidence in all eight books tends to support this as a strategy that extends to other diagnoses.

In response to Don’s final question I do not believe that “off label” use should be forbidden by the FDA. This is a legitimate way in which an individual expert in the field can make new discoveries. What should be forbidden is for the use of such data to promote a medication for a new indication before it has been independently evaluated under FDA guidelines to confirm its efficacy and safety.